Deck 27: Adults

Question 1

For patients diagnosed with severe and persistent mental illness, what is the major advantage of case management? A case manager can:

A) modify traditional psychotherapy.
B) efficiently access and use resources.
C) focus on social skills training and self-esteem building.
D) bring groups of patients together to discuss common problems.

Answer 1

efficiently access and use resources.

Question 2

A patient diagnosed with severe and persistent mental illness lives in a homeless shelter. The priority nursing diagnosis for this patient is Powerlessness. Which intervention should be included in the plan of care?

A) Encourage mutual goal setting.
B) Verbally communicate empathy.
C) Reinforce participation in activities.
D) Demonstrate an accepting attitude.

Answer 2

Encourage mutual goal setting.

Question 3

A 37-year-old is involuntarily committed to outpatient treatment after sexually molesting a 12-year-old child. The patient says, "That girl looked like she was 19 years old." Which defense mechanism is this patient using?

A) Denial
B) Identification
C) Displacement
D) Rationalization

Answer 3

Rationalization

Question 4

The father of a child diagnosed with schizophrenia says, "I lost my job, so we have no health insurance." The mother says, "I must watch this child all the time. Without supervision, our child becomes violent and destructive." A sibling says, "My parents don't pay attention to me." These comments signify:

A) life-cycle stressors.
B) psychobiologic issues.
C) family burden of mental illness.
D) stigma associated with mental illness.

Question 5

A nurse prepares a plan of care for a patient diagnosed with adult attention deficit hyperactivity disorder (ADHD). Which intervention should be included?

A) Remind the patient of priorities and deadlines.
B) Teach work-related skills such as basic computer literacy.
C) Establish penalties for failing to organize and prioritize tasks.
D) Give encouragement and strategies for managing and organizing.

Question 6

A nurse counsels a patient diagnosed with serious and persistent mental illness. The patient lives at home with family. Which resource could the nurse suggest to assist the patient and family to cope with the stigma of mental illness as well as provide support and education?

A) American Psychiatric Association (APA)
B) National Alliance on Mental Illness (NAMI)
C) Community Mental Health Centers (CMHCs)
D) Programs of Assertive Community Treatment (PACT)

Question 7

The parent of an adult diagnosed with severe and persistent mental illness asks the nurse, "Why are you making a referral to that vocational rehabilitation program? My child won't ever be able to hold a job." Which is the nurse's best reply?

A) "We made this referral to maintain eligibility for federal funding."
B) "Are you concerned that we're trying to make your child too independent?"
C) "If you think the program would be detrimental, we can postpone it for a time."
D) "Most patients are capable of employment at some level, competitive or supported."

Question 8

A person diagnosed with severe and persistent mental illness enters a shelter for the homeless. Which intervention should be the nurse's initial priority?

A) Develop a relationship
B) Find supported employment
C) Administer prescribed medication
D) Teach appropriate health care practices

Question 9

A homeless patient diagnosed with severe and persistent mental illness became suspicious and delusional. The patient was given depot antipsychotic medication and housing was arranged at a local shelter. After 2 weeks, which statement by the patient indicates significant improvement?

A) "I am feeling safe and comfortable here. Nobody bothers me."
B) "They will not let me drink. They have many rules in the shelter."
C) "Those guys are always watching me. I think someone stole my shoes."
D) "That shot made my arm sore. I'm not going to take any more of them."

Question 10

An adult diagnosed with attention deficit hyperactivity disorder (ADHD) says, "I've always been stupid. I never had friends when I was a child. My parents often punished me because I made mistakes. Now, I can't keep a job." The nurse managing care should consider:

A) aversive therapy to extinguish negative behaviors.
B) cognitive therapy to help address internalized beliefs.
C) group therapy to allow comparison of feelings with others.
D) vocational counseling to identify needed occupational skills.

Question 11

Which nursing diagnosis is likely to apply to the plan of care for a homeless individual diagnosed with severe and persistent mental illness?

A) Insomnia
B) Substance abuse
C) Chronic low self-esteem
D) Impaired environmental interpretation syndrome

Question 12

A patient diagnosed with severe and persistent mental illness lives independently. This patient often has command hallucinations and shouts warnings to neighbors. After a short hospitalization, the patient's landlord says, "You can't come back here. You cause too much trouble." What problem is the patient experiencing?

A) Grief
B) Stigma
C) Recidivism
D) Lack of insurance parity

Question 13

Health maintenance and promotion efforts for patients diagnosed with severe and persistent mental illness should include education about the importance of regular:

A) home safety inspections.
B) monitoring of self-care abilities.
C) screening for cancer, hypertension, and diabetes.
D) determination of adequacy of a patient's support system.

Question 14

A nurse prepares for an initial interview with a patient with suspected adult attention deficit hyperactivity disorder (ADHD). Questions should be focused to elicit information about which problem?

A) Headaches
B) Inattention
C) Sexual impulses
D) Trichotillomania

Question 15

Which nursing action should occur first when preparing to work with a patient who has a problem of sexual functioning?

A) Acquire knowledge of the patient's sexual roles and preferences
B) Develop an understanding of human sexual responses
C) Assess the patient's sexual functioning
D) Clarify the nurse's own personal values

Question 16

The treatment team believes medication will help a patient diagnosed with adult attention deficit hyperactivity disorder (ADHD). Which class of medications does the nurse expect will be prescribed?

A) Benzodiazepines
B) Psychostimulants
C) Antipsychotics
D) Anxiolytics

Question 17

A patient says, "I often make careless mistakes and have trouble staying focused. Sometimes it's hard to listen to what someone is saying. I have problems putting things in the right order and often lose equipment." Which problem should the nurse document?

A) Inattention
B) Impulsivity
C) Hyperactivity
D) Social impairment

Question 18

Severe and persistent mental illness is best characterized as a:

A) mental illness with longer than 2 weeks' duration.
B) major ongoing mental illness marked by significant functional impairments.
C) mental illness accompanied by physical impairment and severe social problems.
D) major mental illness that cannot be treated to prevent deterioration of cognitive and social abilities.

Question 19

An adult says, "When I was a child, I took medication because I couldn't follow my teachers' directions. I stopped taking it when I was about 13. I still have trouble getting organized, which causes difficulty at my job." Which disorder is most likely?

A) Stress intolerance disorder
B) Generalized anxiety disorder (GAD)
C) Borderline personality disorder
D) Adult attention deficit hyperactivity disorder (ADHD)

Question 20

A patient diagnosed with schizophrenia tells the community mental health nurse, "I threw away my pills because they interfere with God's voice." The nurse identifies the cause of the patient's ineffective management of the medication regimen as:

A) inadequate discharge planning.
B) poor therapeutic alliance with clinicians.
C) impaired reasoning secondary to schizophrenia.
D) dislike of the side effects of antipsychotic medications.

Question 21

Which economic factors are most critical to the success of discharge planning for a patient diagnosed with severe and persistent mental illness? (Select all that apply.)

A) Access to housing
B) Individual psychotherapy
C) Income to meet basic needs
D) Availability of health insurance
E) Ongoing interdisciplinary evaluation

Question 22

A man tells the nurse, "All my life, I have felt and acted like a woman while living in a man's body. For the past year, I have lived and dressed as a woman. I changed jobs to protect my new identity." Which request is the patient likely to make to the health care provider?

A) "Can you refer me for psychological testing?"
B) "Will you prescribe estrogen therapy?"
C) "Will you alter my medical records?"
D) "What should I tell my parents?"

Question 23

Before working with patients regarding sexual concerns, a prerequisite for providing nonjudgmental care is:

A) sympathy.
B) assertiveness training.
C) sexual self-awareness.
D) effective communication.

Question 24

Which information should a nurse include in health teaching for adults diagnosed with attention deficit hyperactivity disorder (ADHD) and their significant others? (Select all that apply.)

A) Tendency for genetic transmission
B) Prevention strategies related to substance abuse
C) Negative reinforcement strategies to help modify behaviors
D) Selective serotonin reuptake inhibitors (SSRIs) are usually prescribed for hyperactivity
E) Cognitive therapy may help resolve internalized negative beliefs about self

Question 25

An adult patient tells the case manager, "I don't have bipolar disorder anymore, so I don't need medicine. After I was in the hospital last year, you helped me get an apartment and disability checks. Now I'm bored and don't have any friends." Which resources should the nurse suggest for the patient? (Select all that apply.)

A) Psychoeducation classes
B) Vocational rehabilitation
C) Social skills training
D) Homeless shelter
E) Crisis intervention

Question 26

A patient diagnosed with severe and persistent mental illness who recently moved to a homeless shelter says, "My life is out of control. I'm like a leaf at the mercy of the wind." The nurse formulates the diagnosis Powerlessness. Outcomes will focus on:

A) instilling hope.
B) controlling anxiety.
C) planning social activities.
D) developing personal autonomy.

Question 27

A patient tells the nurse, "My sexual functioning is normal when my partner wears lace. Without it, I'm not interested in sex." This comment evidences:

A) exhibitionism.
B) voyeurism.
C) pedophilia.
D) fetishism.

Question 28

A nurse cares for a patient diagnosed with paraphilia. The nurse expects the health care provider may prescribe which type of medication to reduce paraphilic behaviors?

A) Selective serotonin reuptake inhibitor (SSRI)
B) Erectile dysfunction medication
C) Atypical antipsychotic medication
D) Mood stabilizer

Question 29

An adult has been feeling significant tension since losing a home through foreclosure. This person goes to a park, feeds the birds, and then impulsively exposes himself to a group of parents and children. Which term applies to this behavior?

A) Voyeurism
B) Frotteurism
C) Exhibitionism
D) Sexual masochism

Question 30

Which statements most clearly indicate that the speaker views mental illness with stigma? (Select all that apply.)

A) "Everyone is a little bit crazy."
B) "If people with mental illness would go to church, their problems would be solved with faith."
C) "Many mental illnesses are genetically transmitted. It is no one's fault that the illness occurs."
D) "Anyone can have a mental illness. War or natural disasters can be too stressful for healthy people."
E) "People with mental illness are lazy. They expect the government to take care of everything they need."

Question 31

The manager of a health club put a hidden camera in the women's locker room and videotaped women as they showered and dressed. Which sexual dysfunction is evident?

A) Frotteurism
B) Exhibitionism
C) Pedophilia
D) Voyeurism